title: Tailoring antibody testing and how to use it in the calculated panel reactive antibody era: the Northwestern University experience.
abstract: BACKGROUND
  Patients with human leukocyte antigen antibodies constitute a significantly disadvantaged population among those awaiting renal transplantation. We speculated that more understanding of the patients' antibody makeup would allow a more "immunologic" evaluation of crossmatch data, facilitate the use of virtual crossmatch (XM), and lead to more transplantability of these patients.
  
  
  METHODS
  We retrospectively compared the transplantability and transplant outcome of two consecutive patient populations transplanted in our center. Group I (n=374) was evaluated using solid-phase base testing for determination of percentage panel reactive antibody ("PRA screen") with limited antibody identification testing. Group II (n=333) was tested in a more comprehensive manner with major emphasis on antibody identification, antibody strength assignment, and the use of pronase for crossmatch.
  
  
  RESULTS
  Given this approach, 49% (166/333) of the transplanted patients in group II were sensitized compared with 40% (150/374) of the recipients in group I; P=0.012. Transplant outcome at 1-year posttransplant was similar in both groups.
  
  
  CONCLUSIONS
  We conclude that comprehensive evaluation of human leukocyte antigen sensitization and application of immunologic in analyzing compatibility between donor and recipient can increase the transplantability of sensitized patients while maintaining similar outcome. Our approach is in line with United Network for Organ Sharing new guidelines for calculated panel reactive antibody and virtual XM analysis. We hope this report will prompt additional transplant programs to consider how they will use the new United Network for Organ Sharing algorithms.
authors.affiliation: Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. a-tambur@northwestern.edu
authors.forename: Anat R
authors.initials: AR
authors.lastname: Tambur
authors.forename: Joseph
authors.initials: J
authors.lastname: Leventhal
authors.forename: Dixon B
authors.initials: DB
authors.lastname: Kaufman
authors.forename: John
authors.initials: J
authors.lastname: Friedewald
authors.forename: Joshua
authors.initials: J
authors.lastname: Miller
authors.forename: Michael M
authors.initials: MM
authors.lastname: Abecassis
mesh_terms: D000328:Adult; D000465:Algorithms; D000918:Antibody Specificity; D002641:Chicago; D003141:Communicable Diseases / Q000276:immunology; D003663:Decision Trees; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D019983:Guideline Adherence; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007114:Immunization; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D014495:Universities; D014584:User-Computer Interface
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies